Patient Care – Adult cardiac, endovascular, and thoracic aortic surgery

Patient appointments & physician referrals: please call 210-450-0999.

A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.

Aortic rupture (a tear in the aorta, which is the major artery coming
from the heart) can be seen on a chest X-ray. In this case, it was
caused by a traumatic perforation of the thoracic aorta. This is how the
X-ray appears when the chest is full of blood (right-sided hemothorax)
seen here as cloudiness on the left side of the picture.

Causes, incidence, and risk factors:
Thoracic aortic aneurysms are caused by hardening of the arteries
(atherosclerosis), high blood pressure (hypertension), congenital
disorders such as Marfan’s syndrome, trauma, or less commonly, syphilis.

Atherosclerosis is by far the most common
cause.

Thoracic aneurysms occur in the ascending aorta (25% of the time), the
aortic arch (25% of the time), or the descending thoracic aorta (50% of
the time).

Risk factors include various connective tissue disorders (such as
Marfan’s syndrome), atherosclerosis, previous
dissection of the aorta,
prolonged hypertension, and trauma
(usually falls or motor vechicle
accidents).

Symptoms: Most patients have no symptoms until the aneurysm begins to leak or
expand. Most non-leaking thoracic aortic aneurysms are detected by tests
— usually a chest X-ray or a chest CT scan — run for other reasons.
Chest or back pain may indicate acute expansion or leakage of the
aneurysm.

Treatment: The treatment depends on the location of the aneurysm.

Ascending aorta or aortic arch: surgery to replace the aorta is recommended if the diameter of the aorta
measures greater than 5-6 cm. The aorta is replaced with a fabric
substitute in an operation that uses a heart-lung machine. If the aortic
arch is involved, a specialized technique called “circulatory arrest” —
a period without blood circulation while on life support — may be
necessary.

Descending thoracic aorta: two
options are available. Aneurysms that are larger than
6 cm, an operation for replacement of the aorta with a fabric substitute
can be done, or the aorta can be stented.

Stenting involves the use of a tube placed inside the vessel and can be
performed without a chest incision, with specialized catheters that are
introduced through arteries at the groin. Not all patients with
descending thoracic aneurysms are candidates for stenting, however.